{
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"OrgName": "TRIANGLE WELLNESS PLLC",
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"FirstLineMailingAddress": "530 NEW WAVERLY PL",
"SecondLineMailingAddress": "SUITE 301",
"MailingAddressCityName": "CARY",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27518-7414",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-851-3480",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7940 WILLIAMS POND LN",
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"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28277-8766",
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"PracticeLocationAddressTelephoneNumber": "704-752-7779",
"PracticeLocationAddressFaxNumber": "704-752-7775",
"EnumerationDate": "03/13/2013",
"LastUpdateDate": "03/13/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRANNON",
"AuthorizedOfficialFirstName": "GREGORY",
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"AuthorizedOfficialTitle": "MEMBER, MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "919-851-3480",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Obesity Medicine (Obstetrics & Gynecology) Physician",
"LicenseNumber": "36499",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}